Provider Demographics
NPI:1932390358
Name:SOUTHCOAST PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:SOUTHCOAST PHYSICIAN SERVICES INC
Other - Org Name:TRUESDALE MEDICAL SPECIALTIES ASSOCIATES LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-985-2011
Mailing Address - Street 1:1030 PRESIDENT AVENUE
Mailing Address - Street 2:SUITE 306C SOUTHCOAST PHYSICIAN SERVICES INC DBA TRUESD
Mailing Address - City:FALL RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-235-6413
Mailing Address - Fax:508-235-6657
Practice Address - Street 1:1030 PRESIDENT AVENUE
Practice Address - Street 2:SUITE 306C SOUTHCOAST PHYSICIAN SERVICES INC DBA TRUESD
Practice Address - City:FALL RIVER
Practice Address - State:MN
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-235-6554
Practice Address - Fax:508-235-6651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCOAST PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory